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Cancer Nurs. 2014 Jan-Feb;37(1):E44-50. doi: 10.1097/NCC.0b013e3182813a17.

The Cancer Worry Scale: detecting fear of recurrence in breast cancer survivors.

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Author Affiliations: Departments of Medical Psychology (Mss Custers, van den Berg, and Drs Gielissen and Prins) and Medical Oncology (Dr van Laarhoven), Radboud University Medical Centre, Nijmegen; Department of Medical Oncology, Academic Medical Centre, University of Amsterdam (Dr van Laarhoven); and Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute (Dr Bleiker), Amsterdam, the Netherlands.



In 9% to 34% of cancer patients, the fear of cancer recurrence becomes so overwhelming that it affects quality of life. Clinicians need a brief questionnaire with a cutoff point that is able to differentiate between high- and low-fearful survivors.


This study investigated if the Cancer Worry Scale (CWS) could serve as an instrument to detect high levels of fear of recurrence in female breast cancer survivors.


One hundred ninety-four female breast cancer patients were assessed up to 11 years after their primary treatment for cancer. The women returned the questionnaires including the 8-item CWS, 2 items of the Cancer Acceptance Scale, the Checklist Individual Strength-Fatigue subscale, and the Cancer Empowerment Questionnaire.


A cutoff score of 13 versus 14 (low: ≤13, high: ≥14) on the CWS was optimal for detecting severe levels of fear of recurrence. A cutoff score of 11 versus 12 (low: ≤11, high: ≥12) was optimal for screening. The Cronbach α coefficient of the CWS was .87; evidence to support the convergent and divergent validity of the CWS was also obtained. The CWS is able to detect high levels of fear of recurrence.


The CWS is a reliable and valid questionnaire to assess fear of recurrence in breast cancer survivors.


With the CWS, it is possible for nurses to screen breast cancer survivors for severe levels of fear of cancer recurrence. Thereby, nurses can screen and assist survivors in accessing appropriate and available support.

[Indexed for MEDLINE]

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